Why did I use? Summary

16 September 2020

The goal of this blog is to summarize the causes of addictive behaviours discussed in the past seven weeks.  The starting point was Hashmet (2017) who cited the following seven causes:

1. Genetic Vulnerability
2. Cultural Attitudes
3. Financial Incentives
4. Personality
5. Self-medication
6. Loneliness
7. Incremental: One Step at a Time (Slippery Slope)

The last seven blogs have clearly shown that no single factor accurately describes any individual’s steps toward addiction.  In fact, all the examples discussed demonstrated an interplay of factors.  But that interplay occurred under three main causal headings: genetic, cultural, and personality.  As we see each week, in SMART Recovery meetings, people come to sobriety with concurrent disorders including alcohol addiction + e.g., Narcissistic Personality Disorder; marijuana addiction + e.g., Borderline Personality Disorder; or, meth addiction + genetic vulnerability, as seen through family history i.e., there is no perfect, single causal category because, thankfully, we are truly and utterly individual. 

Which leads to a revised and flexible list of causal factors:

1. Genetic Vulnerability
2. Cultural Factors
   1. Financial Incentives
   1. Self-medication
   1. Slippery Slope
   1. Dionysian Desire
3. Personality
   1. Loneliness
   1. Slippery Slope
   1. Dionysian Desire

The current clinical status of addiction is described in the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-5) under the label Substance Use Disorder (SUD).  Causal factors are not discussed.  The focus of the DSM is categorization and diagnoses, noble concerns when a patient/client presents with SUD.  Within the discussion of criteria, for inclusion in the DSM-5, gambling, sex, and food were not included because, understandably, the first two didn’t include the abuse of a substance while issues of obesity, self-starvation etc. did include a substance (Hasin et al, 2013) but were covered under Food Addiction.

On the ground, in SMART Recovery meetings all over the world, people are welcomed into recovery with food, sex, gambling or substance use issues of various descriptions.  What I find so interesting about this, is that the on-the-street knowledge (and acceptance of claims of similarity) precedes clinical knowledge of the clustering of symptoms, treatments, and causes.  From this observation, it is apparent that the need for connection, voice, and acceptance is at least as great as the need for categorization, diagnosis, and clinical treatment. 

Dan Chalykoff facilitates two weekly voluntary group meetings, as well as private appointments, for SMART-based counselling services at danchalykoff@hotmail.com